The spine and all of its surrounding structures are extremely complex. Similarly back pain is just as complicated. Understanding more about your back and back pain may increase your awareness of what is happening prior to painful episodes. In most cases, people who have chronic reoccurring back pain, have acute flare-ups that they manage accordingly. Unfortunately this also means dealing with pain and disability for a short term. In this segment, I present a couple of common back pain questions and information about acute flare-ups of back pain that may help the next time you “tweak” your back.
Here are the Answers to Common Back Pain Questions:
How can I deal with my pain?
This is a difficult question for patients and healthcare providers alike. The short answer is that it depends. There are numerous ways to deal with back pain and it depends on each person. Different people are different. It depends on your personal coping skills and discovering what movements cause pain and which do not. Some of the most common methods of pain management include manual therapy, heat, ice, over the counter medication, prescription medication, stretching and even exercise. It should be noted that there are active and passive forms of management for back pain. Active management is what you will be doing on your own. This can include exercising, stretching, applying heat or cold and last but not least altering some of your typical movement patterns such as getting out of the car or bed. Bracing your back for movement is a key element of active management.
Sounds simple right? In my opinion managing your back pain falls into two principals:
- First principal: Pain free movements and bracing for movement. Remember that most back pain is mechanical in nature and that means it hurts when you move in certain ways. For example, I see people walk-in who are unable to stand up straight due to pain. In most cases, they have difficulties immediately after sitting for long periods. Back pain sufferers appear hunched over at the mid to low back. Most patients spend far too long in one position (for example, slumped in a comfy chair) that allows tissues to “creep” into painful achy positions. Then, when you initiate movement…. Ouch. Bracing your spine often prepares you for pain free movement.
- Second principal: Coping with pain. Fear of pain is a strong predictor of how people deal with back pain. It also depends on reassurance and guidance from your healthcare provider. It helps to understand that mechanical back pain in the acute stage, although very painful and debilitating, will improve over time. Mechanical back pain is similar to other musculoskeletal injuries and lends itself to “natural history”. The “natural history” (meaning how long will it typically take for the pain to resolve on its own) of acute mechanical back pain, including flare-ups is roughly 4-6 weeks depending on the patient (1). One of the keys to coping with the natural history of your mechanical back pain is to realize that chiropractors and other health care professionals can help. A chiropractor can assist you in decreasing the amount of time returning to normal functioning rather than letting things slowly improve over 4-6 weeks. A chiropractor may often provide a variety of coping strategies and information about your condition.
What is that sharp “catching” type pain I get from time to time?
In theory, “catching” pain suggests joint irritation. I say “in theory” because it is almost impossible to look deep into your back, just at that very moment of sharp pain, and discern what tissue is causing pain (see Part 1). There are many joints in and around the spine that allow you move. Within these joints are tiny receptors that are very effective at sensing movements (termed mechanoreceptors) (2). These tiny receptors can often morph into pain receptors (termed nociceptors) (2). In theory, this conversion would suggest that during certain types of movements that are typically detected by mechanoreceptors are now registered as pain by the nociceptors (2). Here is a simple test to decide whether you have joint irritation or muscle pain. If your back is achy and stiff during the majority of movement time then it’s more likely you have a muscle strain (for example, a long day of moving furniture will cause stiff and achy muscles in your back). If your pain is sharp and only comes on in particular positions this would suggest more joint irritation. The difficulty with deciding on muscle pain versus joint irritation is that they often come together, as the muscle attempts to prevent movement and subsequent joint irritation. Before you self-diagnose your back pain I recommend seeking advice from a spine care specialist. Chiropractors, often considered the primary spine care provider, are an excellent source of information and can help with your back pain.
1. Cynthia K. Peterson, Jennifer Bolton, B. Kim Humphreys. 2012. Predictors of Improvement in Patients With Acute and Chronic Low Back Pain Undergoing Chiropractic Treatment. Journal of Manipulative and Physiological Therapeutics,Vol. 35, Issue 7, Pages 525-533, DOI: 10.1016/j.jmpt.2012.06.003.
2. Chen, Chih-Cheng, Wong, Chia-Wen. 2013. Neurosensory mechanotransduction through acid-sensing ion channels. Journal of Cellular and Molecular Medicine, DOI: 10.1111/jcmm.12025.